Another Pharmacist Gustapo

I went to get my patch refilled and the pharmacist called me back to advise me that the patch is to last three days. I informed him that my doctor has ok'd me to change it every 60 hours. Which was written on the script. The pharmacist then claimed that the manufacturer stated that the patch lasts three days. I told him that it actually also lists that it sometimes needs to be changed earlier up to every two days. He then said okay well as long as you understand. Whatever...shut up and fill the script. Why make a big deal? I have been going to this pharmacy for five months now. I ended up changing to this one because they carry the Sandolz where as my previous one carried the Mylan brand. I have been on the patch for almost a year now. At the same dossage. The only change was a couple of months back my doctor let me increase how often I change the patch. Why do these pharmacist have to make such a big deal out of things? Why can't they fill scripts as written?
Just thought you would all get a kick our of my recent experience.
Have a good day.

Well the pharmacist will come back and say "well, ahem, we have rules and regulations that we have to adhere to etc. etc.". And I can understand that, but not for a repeat customer like that.

AND, how can he give out incorrect information. He either doesn't know his product, or is thinking he can con you into taking a lower dose. Why he thinks that is his job is beyond me.

I'm so lucky that even though I deal with a National store up here I know all the pharmacists and assts. pretty well and even the one that I don't care for treats me well. Twice in her 5 years or so here she has seen an oppportunity to read a Rx two different ways. The obvious way that the Dr. wanted and I'd been taking it like that for 10 years or in a way that is totally opposite everything we've ever done and she took those opportunities to have me run over to get the Dr. to change it - which didn't take THAT long but gimme a break!!

Your pharmacist sounds like an absolute idiot. Seriously. If he were to look in the PDR or the Full Prescribing Information that is included in each box of patches, s/he would read the following (that I'm paraphrasing): Most patients are maintained by changing it every 72 hours, but some patients may need to change their patches every 48 hours. PLEASE NOTE THAT I AM PARAPHRASING AND NOT COPYING THE TEXT FROM THE PRESCRIBING INFO!

I do understand that our litigious society practically demands everyone to cover their particular rear ends, but some of us who are Chronic Pain Sufferers become a little annoyed when we are constantly questioned!

Finally, I wholeheartedly understand the Sandoz vs the Mylan dilemma. Most of the people on this board are tired of my diatribe concerning the Sandoz superiority. After using the Mylan and going through the hell of withdrawals for a month (projectile vomiting and/or diarrhea plus severe pain)--I can't understand anyone finding the Mylan remotely usable. BUT...many people have found relief with them. So, it's just another reason to realize that our systems work differently!

Back to the topic. The suspicious eye of the Gustapo Pharmacist is not amusing.

Sincerely,
Jon (Conductor)

P.S. My Pharmacist, a gentleman I highly regard, informed me that the wholesale cost of the Sandoz vs the Mylan is less than $10 per box. Since our family alone basically keeps this particular Mom and Pop pharmacy in business...he gladly orders the Sandoz for me specifically. All of his other customers use the Mylan.

You know, pharmacist can actually lose their license if something goes wrong, even if they fill what is written on the prescription by the doctor. Pharmacist are more than pill counters.
We live in such a litigious society that it's no wonder some pharmacist are hyper-vigil.**Most of the time healthcare professionals are not out to get you, but covering their own butts because their patients sue at the drop of the hat.

Although specific laws vary from state to state, pharmacists in my state are required to perform a "Drug Use Review" (DUR) on all new prescriptions. Among the many parts of a DUR check is an assessment by the pharmacist of potential over or under utilization of the drug. DUR checks also involve assessing the appropriateness of the chosen drug, and its dose and directions for use as ordered by the physician. The pharmacist also must check for interactions and contraindications between the new drug, the rest of the patient's medication profile, and other medical conditions the patient may have. Because many chronic pain medications (including fentanyl patches) are narcotics that require new, hard copy prescriptions to be presented for each fill, they are processed as new prescriptions each time they are filled and are subjected then to the DUR process repeatedly. The pharmacist can face serious legal repercussions if they fail to perform the DUR check in the manner required by their state law.
When a pharmacist as part of this process identifies an issue with a prescription, its typical for them to ask the patient for additional information to help clarify the situation. Just because the pharmacist may ask you a questions or two about your medication use, it doesn't mean that the pharmacist is objecting to or criticizing the way the drug is being used. It is just as likely that they are asking because an issue has turned up on the DUR check and they are just trying to get the issue resolved. In this particular situation, changing a fentanyl patch every 60 hours is unusual. Typically a 48 hour or 72 hour dosing interval is seen. The pharmacist may have been questioning the dose interval just to make sure that it really was intended to be every 60 hours and that there wasn't just a handwriting error or transcription error in the directions the doctor placed on the new prescription.
Personally, I want my pharmacist to be on their toes and actively working to be sure that my drug therapy is safe and appropriate for me. Pain management drugs aren't candy! They can be very dangerous even when used according to the prescribed directions. I like to know my pharmacist has my back so to speak and works hard to keep me safe!

That's very interesting information Lainini - you sound like you are a pharmacist and certainly you've helped me with the behind the scenes actions that pharmacists have to take. I do wonder, however, how many pharmacists really do go through the DUR check each time a repeat customer presents another prescription for their Duragesic Patches or other narcotics. I know that I've gone to my local pharmacist for my monthly supply of methadone (when I was using it) and only had to wait as little as 5 minutes to get it filled. Can the pharmacist possibly be able to fill out all that information on the DUR check in that amount of time? I just wonder. Thanks for enlightening me on this. All the best - KathyMac

A large portion of the DUR check process is first conducted by the pharmacy's computer system. If the computer system identifies any issues, it locks up the prescription and does not allow it to advance in the filling process until the pharmacist assesses the identified issues and either signs off on them as being safe for the particular patient or the pharmacist takes action to correct any problem that seems to be clinically significant. If no issues are identified and the pharmacy isn't particularly busy at the moment, its completely possible to turn around a prescription in 5 minutes. Too bad they can't all be that fast!

A little interesting aside... Large chain pharmacies have expensive computer systems with all the bells and whistles. Small mom and pop drug stores often can't compete with that kind of technology as it is very expensive. Thus pharmacists who work for the large chains might have their computer systems help them identify more detailed potential problems on a DUR check. To make things even more interesting, sometimes it isn't only the pharmacist doing the DUR check! Many insurance companies perform an automated computer assisted DUR check on their end when the pharmacy submits the prescription claim at the time of fill. If the insurance company's computer identifies an issue, they will initially reject the claim and send a DUR reject remittance advice back to the pharmacy for the pharmacists to evaluate and report back to them on before they will release the claim! In the original fentanyl patch example in this thread, the unusual dosing interval could have easily triggered an insurance prompted DUR reject for the pharmacist to follow-up on.

My best advice to everyone. If a pharmacist asks you a few questions about your use of a medication, don't assume they are being critical. Just answer their questions and then give them a few extra minutes to do their job. They are ultimately trying to protect you!

My favorite pharmacist was filling a script for an anitbiotic for me. She came flying out from the back and asked my why my doctor had prescribed this for me. Now this is at Target..a big chain, right? I told her I didn't know. She looked at me and said I was allergic to pennicillin and this is a derrivitive of pen. and I shouldn't be on it. Told me to sit down and she was going to call my doctor.

Well, the doctor had left for the day. Where I used to take my scripts would have just said come back tomorrow. Not her...she had him paged. Within 10 minutes she had the scipt changed and I was on my way.

This woman keeps my pain meds on hand for my mid month fill from my pm doctor. She knows what I get every month and makes sure she has enough to cover what I normally get scripts for. She told me that she had a pain management docotr tell them what chronic pain patients had to go through and she has never forgotten that. For that I bless her...

I can appreciate someone doing their job. However, as stated in my initial post, I had been taking this medicine at the same dosage, time and location for five months. This is the first time ever that I have been confronted by a pharmacist. So why now? Also, you were not there and have no idea how this person approached me. I don't usually jump to conclusions about people but I do expect respect in return. I was not treated with respect. Instead I was made to feel like I was abusing the medicine. If a pharmacist has issue with a prescription...call the doctor. How does questioning me resolve anything? I am not the one who wrote the prescription. I have done a lot of research on the medicine that I am taking but not everyone does this...what is gained by asking a patient questions on the prescribing methods of their doctor? In my business you don't go to the consumer (the patient), instead you go to the manufacturer (in this case the doctor). This may be coming across a bit snippy but I was not looking for an explanation when I wrote the earlier post. Just sharing an experience.

I am 4 months post back surgery and I began having severe pain in early Aug 06. I have been on Lortab Liguid 7.5/500 ml from around the clock every 4 hours at 15 to 22 mil, to my current reduced scrip of 15ml 4x daily. I am also on Ativan 1 mg (for 3 years) only being off of it while they had me on Valium 3x day at 10mgs for the back pain about 6 months (Ativan for extreme Panic Attck Prevention) along with Cognitive Behavior Therapy. I also take Vistaril 25 mgs 3x day and Blood Pressue and Fluid Meds. I have used the same Pharmacy for years and years now and I have never had a question asked of my until a few weeks ago when the new pharmacist questioned me about my continued use of Lortab. She was rude abrupt and accusing. I signed a paper for pain control/controlled substance when I started the Ativan 3 years ago agreeing not to change Doctors unless refereed to a specialist for a specific condition or I moved and not to change pharmacys which I have complied with to the penny. I do not abuse or sell drugs, but I was made feel that way. I polietely told her why I was on the meds and until August 06 I had not filled a single narcotic prescription in this state only Ativan as prescribed and my normal meds, and I have lived here 14 years and I almost had my arm ripped off in a accident in 1997 and I took Tylenol. She replied that I was on the medication to long and she had reservations about refills. I told her she needed to discuss her concerns with my doctor of 14 years and be advised that he may not take kindly to her questioning his decisions on a patient he has cared for meticiously for 14 almost 15 years, I also told her he does bloodwork every month to monitor my liver functions and kidney functions as well as a CBC and K level. He also does a drug screen every 3 months as part of his compliance order to prescribe Ativan on a continuing basis. I am well cared for and very educated on drugs and there side effects, because I work in the medical field for a living. I also see many people trip from ER to ER drugseeking and they hand out and fill their scrips like candy for 100's of pills without question, but they question me. And I don't even call mine in until the day they are due or sometime the day after because I try to reduce my doses when I can. Yes I am concerned about addiction and I am well aware I will have to wean off both these drugs when the time comes, but I am also intitled to proper pain control without scrutiny or question when I have raised no red flags or gave any cause to be treated like a drug addict or a crimminal. She was rude and accusing and all I was doing was attempting to keep with my doctors blessing chronic pain in check enough to continue my daily living without suffering. Yet I see fakers in my line of work all the time and guess what we have to prescribe to them if they claim to be in pain, its part of the patients rights and responsibilities act that includes pain control in my state.
I have spent thousands of dollars at this pharmacy, and I mean thousands over the years 10s of thousands for my entire family. and I did not feel I deserved on had done anything to be treated in the manner she treated me that day. Needless to say I spoke to the head pharmicist about her rudeness and she has been nothing but polite since. So while I understand the need for checks and for a pharmacist to pay attention and watch for abuse, I also expect them to use common sense when dealing with their customers especially those who have no red flags
Just my opinion K

I always want my pharmacist to check things and get them right and they have always been able to do that without making me feel like I'm doing something wrong.

If he didn't know it could be Rx every 48 hours then shame on him. I was on it for a few months a few years ago and that was the first thing that my Dr. and pharmacist told me when I picked it up. I too ended up needing it every 60 hours.

If he DID know that then I do not think it is his business to be trying to prescribe for you. The Rx is well within the guidelines. He was - at first until he found out that you KNEW about this medication - suggesting/telling you that you were doing something wrong. I wonder what he would have had you do if you did NOT know about the med.? A million things come to mind!! LOL.

Zach, That is exactly my point. What if I wasn't up on the prescription? Would he change it? He kind of already did. I received two boxes which I change every 2 1/2 days = 25 day supply 2.5*10...he wrote on the boxes it was a 26 day of supply. I really think he was trying to screw with me. Annoying.

Hi guys...
I find that newer, younger, bored or pharmacists that failed the test to be cops are the worst...most of you know my humor and will think this is funny, and to those of you who dont, Im sorry if I offended you...Im just sick and tired of being treated like a druggie when i pay top dollar...YES NO insurance for my meds that i need and get crap for it. Luckily I have some pharmacists here that know me, my profession and KNOW thats not the case...point being...chain pharmacy...new pharmacist from the "big city" scolded me on a refill, and after a call from my doc, and a talking to from the mgr...now she calls me by by first name and gets my scrips done ASAP... When i asked the head pharmacist about it he stated that she was leery because shed come from a big town...I hate to see how she treated others, until she got to know them...still sucks if you ask me. i still feel like they think they are cops...i only go these guys for my patches, and i go elsewhere for my BT meds and Im switching next week to the mom and pop...
xoxoxoxox,

I completely agree that a pharmacist should never be rude or accusing when questioning a patient about their drug therapy. Unfortunately not everyone has the best social skills, including some pharmacists! My effort in this thread has been to try to reassure some of you that were offended when a pharmacist asked them questions about their use of a drug. I am a chronic pain patient myself and use oxycodone ER and hydrocodone/apap on a daily basis to get through each day. I have suffered severe neck pain for years that was not treated as my family doctor kept assuring me that nothing was wrong with my neck. As it turned out, there were serious problems going on in my neck that required surgical correction and despite the surgery my pain problems continue. Only recently did my pain get addressed with medications that have made my life much more comfortable and functional. I too would be very offended and upset if I felt like someone was questioning my need for or use of those medications! But sometimes pharmacists have to ask some questions to do their job correctly as I tried to explain in my earlier posts. Its best to just answer the questions they might ask as truthfully and matter of factly as possible and let them get their job done.

There is one more little tidbit of information that I can share that might help some of you feel better if questioned. If the pharmacist asks you directly about your drug therapy, the pharmacist is likely just gathering the information they need to do their job. If a pharmacist truly thinks you are abusing a drug, forging or altering a prescription for a drug, or using one in a dangerous or unusual manner, the pharmacists is likely to call the prescriber directly without bothering to talk to you at all.

Just because a pharmacist fills a prescription exactly as written by the doctor and for an FDA approved dosage, it doesn't make the drug less dangerous. People die every day from the use of prescription drugs that were prescribed and dispensed within FDA guidelines. That is the whole reason why access to prescription drugs is so regulated.

Thanks~
I think a lot of ppl are tired of being in pain, and being treated like ***** for needing the drugs they need to control their pain...Thats all...it gets so tiring and hard enough to deal with, we dont need any crap about getting what we need to help us~
xooxoxoxox,
IZZY'SMOM